Sinha Abhinav, Mehtani Anil, Sud Alok, Vijay Vipul, Kumar Nishikant, Prakash Jatin
Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India.
Indian J Orthop. 2016 Sep;50(5):529-535. doi: 10.4103/0019-5413.189597.
Gentle passive manipulation and casting by the Ponseti method have become the preferred method of treatment of clubfoot presenting at an early age. However, very few studies are available in literature on the use of Ponseti method in older children. We conducted this study to find the efficacy of Ponseti method in treating neglected clubfoot, which is a major disabler of children in developing countries.
41 clubfeet in 30 patients, presenting after the walking age were evaluated to determine whether the Ponseti method is effective in treating neglected clubfoot. This is a prospective study. Pirani and Dimeglio scoring were done for all the feet before each casting to monitor the correction of deformity. Quantitative variables were expressed as mean ± standard deviation and compared between preoperative and postoperative followup using the paired -test. Also, the relation between the Pirani and Dimeglio score, and age at presentation with the number of casts required was evaluated using Pearson's correlation coefficient. No improvement in Dimeglio or Ponseti score after 3 successive cast was regarded as failure of conservative management in our study.
The mean age at presentation was 3.02 years (range 1.1 - 10.3 years). The mean followup was 2.6 years (range 2-3.9 years). The mean number of casts applied to achieve final correction were 12.8 casts (range 8 - 18 casts). The mean time of immobilization in cast was 3.6 months. The mean Dimeglio score before treatment was 15.9 and after treatment were 2.07. The mean Pirani score was 5.41 before treatment and 0.12 after treatment. All feet (100%) achieved painless plantigrade feet without any extensive soft tissue surgery. 7 feet (17%) recurred in our average followup of 2.6 years.
Painless, supple, plantigrade, and cosmetically acceptable feet were achieved in neglected clubfeet without any extensive surgery. A fair trial of conservative Ponseti method should be tried before resorting to extensive soft tissue procedure.
庞塞蒂方法进行的轻柔被动手法矫正和石膏固定已成为早期出现的马蹄内翻足的首选治疗方法。然而，关于庞塞蒂方法在大龄儿童中的应用，文献中研究极少。我们开展这项研究以探寻庞塞蒂方法治疗被忽视的马蹄内翻足的疗效，被忽视的马蹄内翻足是发展中国家儿童的主要致残因素。
对30例患者的41只在会走路年龄之后出现的马蹄内翻足进行评估，以确定庞塞蒂方法治疗被忽视的马蹄内翻足是否有效。这是一项前瞻性研究。每次石膏固定前对所有足部进行皮拉尼和迪梅廖评分，以监测畸形矫正情况。定量变量以均值±标准差表示，术前和术后随访结果采用配对t检验进行比较。此外，使用皮尔逊相关系数评估皮拉尼和迪梅廖评分、就诊年龄与所需石膏固定次数之间的关系。在我们的研究中，连续3次石膏固定后迪梅廖或庞塞蒂评分无改善被视为保守治疗失败。
就诊时的平均年龄为3.02岁（范围1.1 - 10.3岁）。平均随访时间为2.6年（范围2 - 3.9年）。实现最终矫正所需的平均石膏固定次数为12.8次（范围8 - 18次）。石膏固定的平均固定时间为3.6个月。治疗前平均迪梅廖评分为15.9，治疗后为2.07。治疗前平均皮拉尼评分为5.41，治疗后为0.12。所有足部（100%）均实现无痛、足底放平，且无需任何广泛的软组织手术。在平均2.6年的随访中，7只足部（17%）复发。
无需任何广泛手术，被忽视的马蹄内翻足可实现无痛、柔软、足底放平且外观可接受。在采取广泛的软组织手术之前，应先对庞塞蒂保守方法进行合理尝试。
